First Glance
| Fundamentals | ||||||||||||||||
| Epilepsy In Clinical Pratice -Dr S.V.Khadilkar |
1 2 3 | |||||||||||||||
|
||||||||||||||||
Table 2 describes investigation that should be obtained in patients with epilepsy.
Blood test, electrocardiograms and chest X-ray help pick-up systemic diseases resulting in seizures. EEG has a very important role in the diagnosis of epilepsy. EEG is a useful diagnostic tool to confirm the diagnosis of epilepsy, find out the type of epilepsy, detect the epileptic focus, detect underlying cerebral diseases and evaluate the prognosis. However, EEG is usually done when the patient does not have his attack and so, it could be normal. Thus a normal EEG does not exclude the epilepsy. At the same time, abnormal EEG tracing can be seen in normal individuals and the abnormality in EEG does not make the diagnosis of epilepsy. EEG should be used as an adjunct in the diagnosis of epilepsy. Brain imaging with CT and MRI detects structural lesions, MRI is more sensitive than CT scan but it is more expensive and in our country, the choice of imaging has to be done depending upon cost issues and the clinical situations. Video telemetry and continuous EEG monitoring are not freely available in India and are useful in situations like psychogenic seizures, where organicity of attacks needs to be established, or in situations where the type of seizure is to be analysed in detail, usually for research purposes. The treatment of cases of symptomatic seizures should be directed primarily towards the removal of causative factors. In some cases, it may not be possible to do so, viz. cerebral palsy, then the management turns supportive. |
||||||||||||||||
|
||||||||||||||||
The principal "First Line" antiepileptic drugs are sodium valproate, carbamazepine, phenytoin sodium and phenobarbitone. The patient is usually started on one medicine depending on the
type of seizure. The drug should be started in a small doses and gradually built up to the minimum required dose to control the convulsions. It is important to stress on the patient the need to take medicines regularly and also to have a regular sleep-wake cycle. Up to a point, the epileptic attacks are linked to the biological rhythm and regularity is helpful in developing resistance. All antiepileptic agents have to be used carefully and have side effects. The physician should familiarize himself with the adverse reactions so that they could be detected early and treated effectively. A majority of seizure disorder patients can be effectively controlled with a single antiepileptic drug. Few patients with more stubborn epilepsy may require combination of drugs and the |
||||||||||||||||
1 2 3  |
||||||||||||||||
